Wrap It.

I just finished reading Decisive: How to Male Better Choices in Life and Work by Chip and Dan Heath. If you have an interest in making better decisions you should read this book.

The core concept of the book is the WRAP process. In the heat of the moment it can be hard to remember all of this so I made a pocket sized cheat sheet to consult before making some decisions. It is tailored to my needs and some of it may not make sense to you, some of it is a bit abbreviated. You obviously cannot completely avoid some of the biases, but for the sake of brevity I put “avoid” instead of “really try to avoid…”

For example: I am not a morning person, at all. I am cranky until I have ingested about 600mg of caffeine and should probably make as few decisions as possible before 10am. We were having a discussion about our protocols and if we should approach the state to attempt to get a waiver for non critical care certified paramedics to transport patients on levophed on inter-facility transfers. Should we or shouldn’t we ask the state?

I was going back and forth with it internally. No we should just require everyone to get a critical care certification. Maybe we should try for the waiver so that it shares the load among the crew, so yes? No, why should people get to have the standards lowered, they should have to do the work like I did and get an FP-C. Yes, it isn’t rocket science, it is titrating a medication to a BP. No, because then what was the point of me getting a CC cert? No, because it is going to mean we cannot charge the medicare SCT billing rate when they take the transfer. Yes, because we should focus on building people up. I don’t know…

Should we do it or not?

I was still several hundred milligrams short of my therapeutic dose of caffeine when a single neuron somehow fired and I was able to form a cogent thought. I realized I was falling victim to narrow framing and the the trap of “should we or shouldn’t we?” I needed to widen my view and figure out my goals.

The wider view was simply to ask what are we trying to accomplish here? We are trying to get sick patients to the right place in a timely manner. Often the weather shuts down the option of flying and they must go by ground transport for 2-3 hours from the local level IV to a level II or I hospital. It would be tragic to make a patient sit in a ER room or get admitted to a level IV when that is what they do not need. We are trying to get patients to where they should go in a timely manner, does approaching the state about a waiver for non-critical care paramedics to transport vaso-active medications on IFTs align with these goals? I think it does. Can it be done safely with the proper training and education? I would say yes.

“Yes, we should approach the state about a waiver.

And then I slowly sunk back in to the haze that is my early morning and wondered if I should or should not have another cup of coffee.

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